Provider Demographics
NPI:1003356502
Name:PALMER, BEVERLY A (LPN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:PALMER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 FREEDOM DR
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-9038
Mailing Address - Country:US
Mailing Address - Phone:419-599-1660
Mailing Address - Fax:419-592-8336
Practice Address - Street 1:701 JEFFERSON AVE SUITE 301
Practice Address - Street 2:FAMILY SERVICES OF NWO
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604
Practice Address - Country:US
Practice Address - Phone:419-244-5511
Practice Address - Fax:419-592-8336
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN088950164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse